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All stakeholders, including citizens, NGOs, etc. have an important role in the law making process. But for many stakeholders, the process is not obvious or easily explained. In PRS, we often receive a number of requests from NGOs about how it is that they can get Parliament to make changes in legislation and what would be productive ways in which citizens can make a difference in the law making process. To address this, PRS has developed a short Primer on "Engaging with Policy Makers: Ideas on Contributing to the Law Making Process", in which we have tried to explain the process of how a Bill becomes an Act and some of the opportunities for citizen groups to become part of the process. Sometimes, large parts of a Bill that is introduced in Parliament may not be agreeable to some groups. In such cases there is a tendency among NGOs to sometimes decide to redraft the Bill. To the extent that NGOs think of redrafting a Bill as a tactical negotiating position, they may have a point in trying to redraft legislation. To the extent that NGOs think of such redrafting as a way to keep the discourse alive on the most important issues in any legislation, such efforts are welcome and useful. But if there is a belief that the Bill introduced in Parliiament will be withdrawn to introduce another Bill on the same subject as drafted by NGOs, then history suggests that the probability of that happening is close to zero. This is not a comment on the quality of the Bill that may be drafted by the group of NGOs, but rather a result of a complex set of issues about lawmaking in India. Despite the odds, there are some recent examples in which NGOs were able to bring about significant changes to Bills in Parliament. The Right to Information Act stands out as one of the best examples in recent times. On the recently passed Right to Education Bill, NGOs were able to exert sufficient pressure to bring about changes in the Bill, and also get the government to bring in an amendment Bill to make further changes. In the Seeds Bill which was introduced in 2004, the Government appears to have agreed to bring about important changes thanks to the efforts of a number of farmer groups approaching the government directly, and through their local MPs and political parties. It would be useful if we can get more examples/ comments/ suggestions about how some NGOs were able to bring about these changes in Bills. This will help more people understand how their voices can be heard in the corridors of power.

The Parliamentary Standing Committee on Health and Family Welfare tabled a Report in Parliament on May 8, 2012, on the functioning of the Central Drugs Standard Control Organization (CDSCO).  CDSCO is the agency mandated with the regulation of drugs and cosmetics in India.  The Report covers various aspects of drug regulation including organizational structure and strength of CDSCO, approval of new drugs, and banning of drugs, among others. Following the Report, the Minister of Health and Family Welfare has constituted a Committee to look into the procedure for drug regulation.  The Committee is expected to make its submissions within a period of two months. This post focuses on irregularities in the approval of new drugs by CDSCO.  It discusses the regulations relating to drug approval and the Standing Committee's observations on the working of CDSCO. Approval of new drugs Drugs are regulated by the Drugs and Cosmetics Act, 1940 and Drugs and Cosmetic Rules, 1945 [Rules].  The CDSCO, under the Ministry of Health and Family Welfare, is the authority that approves new drugs for manufacture and import.  State Drug Authorities are the licensing authorities for marketing drugs. New Drugs are defined as:

  • drugs that have not been used in the country before,
  • drugs that have been approved by a Licensing Authority but are now being marketed for different purposes, and
  • fixed dose combinations of two or more drugs that have been individually approved before but are proposed to be combined in a fixed ratio that has not been approved.

The Rules require an applicant for a new drug to conduct clinical trials in India to determine the drug’s safety and efficacy.  These trials are necessary for both domestically manufactured and imported drugs.  However, the authority can exempt a drug from the requirement of local and clinical trials in the public interest based on data available in other countries. Observations and recommendations of the Committee The Committee found that a total of 31 new drugs were approved between January 2008 and October 2010 without conducting clinical trials on Indian patients.  The Report mentioned that drug manufacturers, CDSCO officials and medical experts colluded to approve drugs in violation of laws.  Following are some of the Report’s findings:

  • Under the Rules, the Drugs Controller General (India) (DCGI), the head of CDSCO, can clear sites of clinical trials after ensuring that major ethnic groups are enrolled in these trials to have a truly representative sample.  This rule was violated by the DCGI when sites for clinical trials were approved without ensuring diversity.  The Committee recommended that the DCGI approve sites for trials only if they cover patients from major ethnic backgrounds.
  •  The Report found that certain actions by experts were in violation of the Code of Ethics of the Medical Council of India.  A review of expert opinions revealed that several medical expert recommendations had been given as personal opinions rather than on the basis of scientific data.  Additionally, many expert opinions were written by what the Report calls ‘the invisible hands’ of drug manufacturers.  The Committee recommended that CDSCO formulate a clear set of written guidelines on the selection process of experts with emphasis on expertise in the area of drugs.
  •  The Rules ban the import and marketing of any drug whose use is prohibited in the country of origin.  CDSCO violated this rule by approving certain Fixed Dose Combination drugs for clinical trials without considering the drugs’ regulatory status in their respective country of origin.  Drugs such as Deanxit and Buclizine, which have been prohibited for sale and use in their countries of origin, Denmark and Belgium, respectively, were approved for clinical trials.  The Committee recommended an inquiry into the unlawful approval of these drugs.
  • The Rules require animal studies to be conducted for approval of a drug for use by women of reproductive age.  CDSCO violated this rule in approving Letrozole for treating female infertility.  Globally the drug has only been used as an anti-cancer drug for use among post-menopausal women.  The drug has not been permitted for use among women of reproductive age because of side effects.  The Committee recommended that responsibility be fixed for unlawfully approving Letrozole.
  •  Rules require Post-marketing Safety Update Reports (PSURs) on drugs to be submitted to CDSCO.  PSURs are used to collect information on adverse effects of drugs on Indian patients as a result of ethnic differences.  When asked by the Committee to furnish PSURs on 42 randomly selected new drugs, the Ministry was able to submit PSURs for only 8 drugs.  The Report contended that this action reflected a poor follow-up of side effects on Indian patients.  The Committee recommended that manufacturers of new drugs be warned about suspension of marketing approval unless they comply with mandatory rules on PSURs.